Mixed methods, single case design, feasibility trial of a motivational conversational agent for rehabilitation for adults with traumatic brain injury.

OBJECTIVE: Rehabilitation for adults with traumatic brain injury (TBI) incorporates client-centred goal-setting and motivational support to achieve goals. However, face-to-face rehabilitation is time-limited. New therapy approaches which leverage care are warranted. Conversational agents (CAs) offer a human-computer interface with which a person can converse. This study tested the feasibility, usability and acceptability of using a novel CA - RehabChat - alongside brain injury rehabilitation. DESIGN: Mixed methods, single case design, feasibility pilot trial. SETTING: Ambulatory and community brain injury rehabilitation. PARTICIPANTS: Adults with TBI receiving brain injury rehabilitation and clinicians providing this care. INTERVENTION: Following 1:1 training, client-clinician dyads used RehabChat for two weeks alongside usual care. MAIN MEASURES: Pre-post clinical measures (Motivation for Traumatic Brain Injury Rehabilitation Questionnaire, Rehabilitation Therapy Engagement Scale, Brain Injury Rehabilitation Trust Motivation Questionnaire-Relative, Brain Injury Rehabilitation Trust Motivation Questionnaire-Self) repeated measures (Hospital Anxiety and Depression Scale, researcher-developed wellbeing screening questions); and post-intervention (System Usability Scale (SUS), semi-structured 1:1 interview). RESULTS: Six participants (two clients and four clinicians) completed training. Two client-clinician dyads completed the intervention. Two other clinicians used RehabChat in a mock client-clinician session. SUS scores indicated good usability. Client well-being did not deteriorate. No adverse events were experienced. Interviews indicated RehabChat was feasible, acceptable and easy to use; and supported motivation, goal-setting and completing practice activities. CONCLUSIONS: RehabChat was feasible and acceptable to use alongside usual ambulatory and community brain injury rehabilitation, had good usability and supported client needs. Further testing of RehabChat with a larger cohort for longer duration is warranted.

Older adults' community participation, physical activity, and social interactions during and following COVID-19 restrictions in Australia: a mixed methods approach.

BACKGROUND: With the increasing age of the global population, key components of healthy ageing including community, physical, and social participation continue to gain traction. However, management of the COVID-19 pandemic aimed to protect older adults and reduce the spread of the virus, this restricted community participation and reduced the opportunities for social interaction. METHODS: This mixed methods study investigates community dwelling older adults' community participation; physical activity and social interaction prior to, during, and following the COVID-19 lockdown in Adelaide, Australia. Twenty-six community dwelling older adults were monitored over three time-points between November 2018 and October 2020, with Global Positioning Systems, accelerometry and self-reported diaries. In addition, nineteen participants completed semi-structured interviews. RESULTS: Community participation varied across the three time points, with significant reduction in the number of trips taken out-of-home (p = 0.021), social interactions (p = 0.001) and sleep quality (p = 0.008) during restrictions. Five themes were identified to explain personal experiences of community participation during restrictions: (1) Reframing of meaning, (2) Redefining to maintain activities, (3) Revision of risk, (4) Reflection and renewal and (5) Future planning. CONCLUSION: During COVID-19 the physical and social activities of community dwelling older adults changed. Services that support older adults to adapt their activities   , considering their capacities and preferences, to facilitate community participation are required.

Machine learning models for identifying pre-frailty in community dwelling older adults.

BACKGROUND: There is increasing evidence that pre-frailty manifests as early as middle age. Understanding the factors contributing to an early trajectory from good health to pre-frailty in middle aged and older adults is needed to inform timely preventive primary care interventions to mitigate early decline and future frailty. METHODS: A cohort of 656 independent community dwelling adults, aged 40-75 years, living in South Australia, undertook a comprehensive health assessment as part of the Inspiring Health cross-sectional observational study. Secondary analysis was completed using machine learning models to identify factors common amongst participants identified as not frail or pre-frail using the Clinical Frailty Scale (CFS) and Fried Frailty Phenotype (FFP). A correlation-based feature selection was used to identify factors associated with pre-frailty classification. Four machine learning models were used to derive the prediction models for classification of not frail and pre-frail. The class discrimination capability of the machine learning algorithms was evaluated using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, precision, F1-score and accuracy. RESULTS: Two stages of feature selection were performed. The first stage included 78 physiologic, anthropometric, environmental, social and lifestyle variables. A follow-up analysis with a narrower set of 63 variables was then conducted with physiologic factors associated with the FFP associated features removed, to uncover indirect indicators connected with pre-frailty. In addition to the expected physiologic measures, a range of anthropometric, environmental, social and lifestyle variables were found to be associated with pre-frailty outcomes for the cohort. With FFP variables removed, machine learning (ML) models found higher BMI and lower muscle mass, poorer grip strength and balance, higher levels of distress, poor quality sleep, shortness of breath and incontinence were associated with being classified as pre-frail. The machine learning models achieved an AUC score up to 0.817 and 0.722 for FFP and CFS respectively for predicting pre-frailty. With feature selection, the performance of ML models improved by up to + 7.4% for FFP and up to + 7.9% for CFS. CONCLUSIONS: The results of this study indicate that machine learning methods are well suited for predicting pre-frailty and indicate a range of factors that may be useful to include in targeted health assessments to identify pre-frailty in middle aged and older adults.

Community participation of community dwelling older adults: a cross-sectional study.

BACKGROUND: With the advancing age of the population, and increasing demands on healthcare services, community participation has become an important consideration for healthy ageing. Low levels of community participation have been linked to increased mortality and social isolation. The extent to which community participation has been measured objectively in older adults remains scarce. This study aims to describe where and how older adults participate in the community and determine the feasibility of measurement methods for community participation. METHODS: This observational cross-sectional study obtained data from 46 community dwelling older adults. A combination of Global Positioning Systems (GPS), accelerometry, and self-reported diaries were used over a 7-day monitoring period. Feasibility of methods were determined by calculating the loss of GPS data, questionnaires, and comparison of self-reported locations with GPS co-ordinates. Relationships between community participation, physical activity, social interactions, health related quality of life, sleep quality and loneliness were explored. RESULTS: Older adults took a median (IQR) of 15 (9.25-18.75) trips out of home over the 7-day monitoring period, most frequently visiting commercial and recreational locations. In-home activities were mainly sedentary in nature, with out of home activities dependent on location type. Self-reported and GPS measures of trips out of home and the locations visited were significantly correlated (self-report 15.7 (5.6) GPS 14.4 (5.8) (r = 0.94)). Significant correlations between both the number of trips taken from home, with social interactions (r = 0.62) and the minutes of moderate to vigorous physical activity (MVPA) (r = 0.43) were observed. Daily MVPA was higher in participants who visited local walk/greenspaces (r = 0.48). CONCLUSION: Participants performed more activities with social interactions out of home and visited commercial locations most frequently. The combination of GPS, accelerometry and self-report methods provided a detailed picture of community participation for older adults. Further research is required with older adults of varying health status to generalise the relationships between community participation, location and physical activity. TRIAL REGISTRATION: Ethical approval was gained from the Flinders University Social and Behavioural Research Ethics Committee (protocol no. 8176).

Health literacy, digital health literacy and the implementation of digital health technologies in cancer care: the need for a strategic approach.

ISSUE ADDRESSED: Digital health technologies can potentially reduce health disparities in cancer care. However, the benefits of digital health technology depend partly on users' digital health literacy, that is, "capabilities and resources required for individuals to use and benefit from digital health resources," which combines health and digital literacy. We examined issues for digital health technology implementation in cancer care regarding digital health literacy, via stakeholder consultation. METHODS: Consumers, health care professionals, researchers, developers, nongovernment and government/policy stakeholders (N = 51) participated in focus groups/interviews discussing barriers, enablers, needs and opportunities for digital health implementation in cancer care. Researchers applied framework analysis to identify themes of digital health literacy in the context of disparity and inclusion. RESULTS: Limited digital and traditional health literacy were identified as barriers to digital technology engagement, with a range of difficulties identified for older, younger and socio-economically or geographically disadvantaged groups. Digital health technology was a potential enabler of health care access and literacy, affording opportunities to increase reach and engagement. Education combined with targeted design and implementation were identified means of addressing health and digital literacy to effectively implement digital health in cancer care. CONCLUSIONS: Implementing digital health in cancer care must address the variability of digital health literacy in recipients, including groups living with disadvantage and older and younger people, in order to be effective. SO WHAT?: If cancer outcome disparity is to be reduced via digital health technologies, they must be implemented strategically to address digital health literacy needs. Health policy should reflect this approach.

Office-based physical activity: mapping a social ecological model approach against COM-B.

BACKGROUND: There are growing concerns over the health impacts of occupational sedentary behaviour on office-based workers and increasing workplace recognition of the need to increase physical activity at work. Social ecological models provide a holistic framework for increasing opportunities for physical activity at work. In this paper we propose a social ecological model of office-based physical activity and map it against the Capability Motivation Opportunity (COM-B) framework to highlight the mechanisms of behaviour change that can increase levels of physical activity of office-based workers. DISCUSSION: The paper proposes a social ecological model of physical activity associated with office-based settings. The model considers opportunities for both incidental and discretionary activities, as well as macro and micro factors on both socio-cultural and physical dimensions. The COM-B framework for characterising behaviour change interventions is used to highlight the underlying mechanisms of behaviour change inherent in the model. The broad framework provided by social ecological models is important for understanding physical activity in office-based settings because of the non-discretionary nature of sedentary behaviour of office-based work. It is important for interventions not to rely on individual motivation for behaviour change alone but to incorporate changes to the broader social ecological and physical context to build capability and create opportunities for more sustainable change.

Health deficits in community dwelling adults aged 40 to 75 years.

BACKGROUND: Middle and older years are associated with age related health deficits but how early this begins and progresses is poorly understood. Better understanding is needed to address early decline and support healthier ageing outcomes. METHODS: Seemingly healthy, community dwelling adults aged 40 to 75 years were recruited via local council and business networks. They completed online surveys about sleep quality, distress and physical activity, and two hours of objective testing of physiologic and anthropometric measures, mobility, cognition, grip strength, foot sensation, dexterity and functional hearing. Analysis compared outcomes for age, gender, and age and gender groups with population norms for 21 health assessments. The total number of non-compliant tests for each participant was calculated by summing the number of non-compliant tests, and the frequency of these scores across the sample was reported. Gender and age effects were tested using ANOVA models. Combined age and gender categories were used for subsequent logistic regression modelling, with females aged 40-49 years being the default comparator. RESULTS: Of 561 participants (67% female; mean age 60 years (SD 10.3)), everyone had at least one deficit and median deficits was 5 (IQR 2). More than 50% of participants did not meet anthropometric and exercise norms, while 30 to 40% had reduced functional hearing and cognition. Overall, men performed worse and deficits increased with age particularly for physical activity, audiology, mobility, anthropometry, oximetry and foot sensation. Heart rate, body temperature and dyspnoea were the only variables where compliance was within 95% of expected values. Multiple areas of functional decline were found in people aged in their 40s and 50s. CONCLUSIONS: The health deficits identified are mostly mutable hence identification and interventions to address the multi-system functional decline in people as young as 40 has the capacity to ensure healthier ageing.

An internet-supported school physical activity intervention in low socioeconomic status communities: results from the Activity and Motivation in Physical Education (AMPED) cluster randomised controlled trial.

OBJECTIVE: Quality physical education (PE) is the cornerstone of comprehensive school physical activity (PA) promotion programmes. We tested the efficacy of a teacher professional learning intervention, delivered partially via the internet, designed to maximise opportunities for students to be active during PE lessons and enhance adolescents' motivation towards PE and PA. METHODS: A two-arm cluster randomised controlled trial with teachers and Grade 8 students from secondary schools in low socioeconomic areas of Western Sydney, Australia. The Activity and Motivation in Physical Education (AMPED) intervention for secondary school PE teachers included workshops, online learning, implementation tasks and mentoring sessions. The primary outcome was the proportion of PE lesson time that students spent in moderate-to-vigorous physical activity (MVPA), measured by accelerometers at baseline, postintervention (7-8 months after baseline) and maintenance (14-15 months). Secondary outcomes included observed PE teachers' behaviour during lessons, students' leisure-time PA and students' motivation. RESULTS: Students (n=1421) from 14 schools completed baseline assessments and were included in linear mixed model analyses. The intervention had positive effects on students' MVPA during lessons. At postintervention, the adjusted mean difference in the proportion of lesson time spent in MVPA was 5.58% (p<0.001, approximately 4 min/lesson). During the maintenance phase, this effect was 2.64% (p<0.001, approximately 2 min/lesson). The intervention had positive effects on teachers' behaviour, but did not impact students' motivation. CONCLUSIONS: AMPED produced modest improvements in MVPA and compares favourably with previous interventions delivered exclusively face-to-face. Online teacher training could help facilitate widespread dissemination of professional learning interventions. TRIAL REGISTRATION NUMBER: ACTRN12614000184673.

The effectiveness of a web 2.0 physical activity intervention in older adults - a randomised controlled trial.

BACKGROUND: Interactive web-based physical activity interventions using Web 2.0 features (e.g., social networking) have the potential to improve engagement and effectiveness compared to static Web 1.0 interventions. However, older adults may engage with Web 2.0 interventions differently than younger adults. The aims of this study were to determine whether an interaction between intervention (Web 2.0 and Web 1.0) and age group (<55y and ≥55y) exists for website usage and to determine whether an interaction between intervention (Web 2.0, Web 1.0 and logbook) and age group (<55y and ≥55y) exists for intervention effectiveness (changes in physical activity). METHODS: As part of the WALK 2.0 trial, 504 Australian adults were randomly assigned to receive either a paper logbook (n = 171), a Web 1.0 (n = 165) or a Web 2.0 (n = 168) physical activity intervention. Moderate to vigorous physical activity was measured using ActiGraph monitors at baseline 3, 12 and 18 months. Website usage statistics including time on site, number of log-ins and number of step entries were also recorded. Generalised linear and intention-to-treat linear mixed models were used to test interactions between intervention and age groups (<55y and ≥55y) for website usage and moderate to vigorous physical activity changes. RESULTS: Time on site was higher for the Web 2.0 compared to the Web 1.0 intervention from baseline to 3 months, and this difference was significantly greater in the older group (OR = 1.47, 95%CI = 1.01-2.14, p = .047). Participants in the Web 2.0 group increased their activity more than the logbook group at 3 months, and this difference was significantly greater in the older group (moderate to vigorous physical activity adjusted mean difference = 13.74, 95%CI = 1.08-26.40 min per day, p = .03). No intervention by age interactions were observed for Web 1.0 and logbook groups. CONCLUSIONS: Results partially support the use of Web 2.0 features to improve adults over 55 s' engagement in and behaviour changes from web-based physical activity interventions. TRIAL REGISTRATION: ACTRN ACTRN12611000157976 , Registered 7 March 2011.

Effectiveness of a Web 2.0 Intervention to Increase Physical Activity in Real-World Settings: Randomized Ecological Trial.

BACKGROUND: The translation of Web-based physical activity intervention research into the real world is lacking and becoming increasingly important. OBJECTIVE: To compare usage and effectiveness, in real-world settings, of a traditional Web 1.0 Web-based physical activity intervention, providing limited interactivity, to a Web 2.0 Web-based physical activity intervention that includes interactive features, such as social networking (ie, status updates, online "friends," and personalized profile pages), blogs, and Google Maps mash-ups. METHODS: Adults spontaneously signing up for the freely available 10,000 Steps website were randomized to the 10,000 Steps website (Web 1.0) or the newly developed WALK 2.0 website (Web 2.0). Physical activity (Active Australia Survey), quality of life (RAND 36), and body mass index (BMI) were assessed at baseline, 3 months, and 12 months. Website usage was measured continuously. Analyses of covariance were used to assess change over time in continuous outcome measures. Multiple imputation was used to deal with missing data. RESULTS: A total of 1328 participants completed baseline assessments. Only 3-month outcomes (224 completers) were analyzed due to high attrition at 12 months (77 completers). Web 2.0 group participants increased physical activity by 92.8 minutes per week more than those in the Web 1.0 group (95% CI 28.8-156.8; P=.005); their BMI values also decreased more (-1.03 kg/m2, 95% CI -1.65 to -0.41; P=.001). For quality of life, only the physical functioning domain score significantly improved more in the Web 2.0 group (3.6, 95% CI 1.7-5.5; P<.001). The time between the first and last visit to the website (3.57 vs 2.22 weeks; P<.001) and the mean number of days the website was visited (9.02 vs 5.71 days; P=.002) were significantly greater in the Web 2.0 group compared to the Web 1.0 group. The difference in time-to-nonusage attrition was not statistically significant between groups (Hazard Ratio=0.97, 95% CI 0.86-1.09; P=.59). Only 21.99% (292/1328) of participants (n=292 summed for both groups) were still using either website after 2 weeks and 6.55% (87/1328) were using either website after 10 weeks. CONCLUSIONS: The website that provided more interactive and social features was more effective in improving physical activity in real-world conditions. While the Web 2.0 website was visited significantly more, both groups nevertheless displayed high nonusage attrition and low intervention engagement. More research is needed to examine the external validity and generalizability of Web-based physical activity interventions. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12611000253909; https://anzctr.org.au /Trial/Registration/TrialReview.aspx?id=336588&isReview=true (Archived by WebCite at http://www.webcitation.org/6ufzw 2HxD).

Using Web 2.0 applications to promote health-related physical activity: findings from the WALK 2.0 randomised controlled trial.

BACKGROUND/AIM: Web 2.0 internet technology has great potential in promoting physical activity. This trial investigated the effectiveness of a Web 2.0-based intervention on physical activity behaviour, and the impact on website usage and engagement. METHODS: 504 (328 women, 126 men) insufficiently active adult participants were randomly allocated to one of two web-based interventions or a paper-based Logbook group. The Web 1.0 group participated in the existing 10 000 Steps programme, while the Web 2.0 group participated in a Web 2.0-enabled physical activity intervention including user-to-user interaction through social networking capabilities. ActiGraph GT3X activity monitors were used to assess physical activity at four points across the intervention (0, 3, 12 and 18 months), and usage and engagement were assessed continuously through website usage statistics. RESULTS: Treatment groups differed significantly in trajectories of minutes/day of physical activity (p=0.0198), through a greater change at 3 months for Web 2.0 than Web 1.0 (7.3 min/day, 95% CI 2.4 to 12.3). In the Web 2.0 group, physical activity increased at 3 (mean change 6.8 min/day, 95% CI 3.9 to 9.6) and 12 months (3.8 min/day, 95% CI 0.5 to 7.0), but not 18 months. The Logbook group also increased physical activity at 3 (4.8 min/day, 95% CI 1.8 to 7.7) and 12 months (4.9 min/day, 95% CI 0.7 to 9.1), but not 18 months. The Web 1.0 group increased physical activity at 12 months only (4.9 min/day, 95% CI 0.5 to 9.3). The Web 2.0 group demonstrated higher levels of website engagement (p=0.3964). CONCLUSIONS: In comparison to a Web 1.0 intervention, a more interactive Web 2.0 intervention, as well as the paper-based Logbook intervention, improved physical activity in the short term, but that effect reduced over time, despite higher levels of engagement of the Web 2.0 group. TRIAL REGISTRATION NUMBER: ACTRN12611000157976.

An Internet-supported Physical Activity Intervention Delivered in Secondary Schools Located in Low Socio-economic Status Communities: Study Protocol for the Activity and Motivation in Physical Education (AMPED) Cluster Randomized Controlled Trial.

BACKGROUND: School-based physical education is an important public health initiative as it has the potential to provide students with regular opportunities to participate in moderate-to-vigorous physical activity (MVPA). Unfortunately, in many physical education lessons students do not engage in sufficient MVPA to achieve health benefits. In this trial we will test the efficacy of a teacher professional development intervention, delivered partially via the Internet, on secondary school students' MVPA during physical education lessons. Teaching strategies covered in this training are designed to (i) maximize opportunities for students to be physically active during lessons and (ii) enhance students' autonomous motivation towards physical activity. METHOD: A two-arm cluster randomized controlled trial with allocation at the school level (intervention vs. usual care control). Teachers and Year 8 students in government-funded secondary schools in low socio-economic areas of the Western Sydney region of Australia will be eligible to participate. During the main portion of the intervention (6 months), teachers will participate in two workshops and complete two implementation tasks at their school. Implementation tasks will involve video-based self-reflection via the project's Web 2.0 platform and an individualized feedback meeting with a project mentor. Each intervention school will also complete two group peer-mentoring sessions at their school (one per term) in which they will discuss implementation with members of their school physical education staff. In the booster period (3 months), teachers will complete a half-day workshop at their school, plus one online implementation task, and a group mentoring session at their school. Throughout the entire intervention period (main intervention plus booster period), teachers will have access to online resources. Data collection will include baseline, post-intervention (7-8 months after baseline) and maintenance phase (14-15 months after baseline) assessments. Research assistants blinded to group allocation will collect all data. The primary outcome will be the proportion of physical education lesson time that students spend in MVPA. Secondary outcomes will include leisure-time physical activity, subjective well-being, and motivation towards physical activity. DISCUSSION: The provision of an online training platform for teachers could help facilitate more widespread dissemination of evidence-based interventions compared with programs that rely exclusively on face-to-face training. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry- ACTRN12614000184673 . Registration date: February 19, 2014.

Examining an Australian physical activity and nutrition intervention using RE-AIM.

Translating evidence-based interventions into community practice is vital to health promotion. This study used the RE-AIM framework to evaluate the larger dissemination of the ManUp intervention, an intervention which utilized interactive web-based technologies to improve the physical activity and nutrition behaviors of residents in Central Queensland, Australia. Data were collected for each RE-AIM measure (Reach, Effectiveness, Adoption, Implementation, Maintenance) using (i) computer-assisted telephone interview survey (N = 312) with adults (18 years and over) from Central Queensland, (ii) interviews with key stakeholders from local organizations (n = 12) and (iii) examination of project-related statistics and findings. In terms of Reach, 47% of participants were aware of the intervention; Effectiveness, there were no significant differences between physical activity and healthy nutrition levels in those aware and unaware; Adoption, 73 participants registered for the intervention and 25% of organizations adopted some part of the intervention; Implementation, 26% of participants initially logged onto the website, 29 and 17% started the web-based physical activity and nutrition challenges, 33% of organizations implemented the intervention, 42% considered implementation and 25% reported difficulties; Maintenance, an average of 0.57 logins and 1.35 entries per week during the 12 week dissemination and 0.27 logins and 0.63 entries per week during the 9-month follow-up were achieved, 22 and 0% of participants completed the web-based physical activity and nutrition challenges and 33.3% of organizations intended to continue utilizing components of the intervention. While this intervention demonstrated good reach, effectiveness, adoption and implementation warrant further investigation.

Validity of the Stages of Change in Steps instrument (SoC-Step) for achieving the physical activity goal of 10,000 steps per day.

BACKGROUND: Physical activity (PA) offers numerous benefits to health and well-being, but most adults are not sufficiently physically active to afford such benefits. The 10,000 steps campaign has been a popular and effective approach to promote PA. The Transtheoretical Model posits that individuals have varying levels of readiness for health behavior change, known as Stages of Change (Precontemplation, Contemplation, Preparation, Action, and Maintenance). Few validated assessment instruments are available for determining Stages of Change in relation to the PA goal of 10,000 steps per day. The purpose of this study was to assess the criterion-related validity of the SoC-Step, a brief 10,000 steps per day Stages of Change instrument. METHODS: Participants were 504 Australian adults (176 males, 328 females, mean age = 50.8 ± 13.0 years) from the baseline sample of the Walk 2.0 randomized controlled trial. Measures included 7-day accelerometry (Actigraph GT3X), height, weight, and self-reported intention, self-efficacy, and SoC-Step: Stages of Change relative to achieving 10,000 steps per day. Kruskal-Wallis H tests with pairwise comparisons were used to determine whether participants differed by stage, according to steps per day, general health, body mass index, intention, and self-efficacy to achieve 10,000 steps per day. Binary logistic regression was used to test the hypothesis that participants in Maintenance or Action stages would have greater likelihood of meeting the 10,000 steps goal, in comparison to participants in the other three stages. RESULTS: Consistent with study hypotheses, participants in Precontemplation had significantly lower intention scores than those in Contemplation (p = 0.003) or Preparation (p < 0.001). Participants in Action or Maintenance stages were more likely to achieve ≥10,000 steps per day (OR = 3.11; 95 % CI = 1.66,5.83) compared to those in Precontemplation, Contemplation, or Preparation. Intention (p < 0.001) and self-efficacy (p < 0.001) to achieve 10,000 steps daily differed by stage, and participants in the Maintenance stage had higher general health status and lower body mass index than those in Precontemplation, Contemplation and Preparation stages (p < 0.05). CONCLUSIONS: This brief SoC-Step instrument appears to have good criterion-related validity for determining Stages of Change related to the public health goal of 10,000 steps per day. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry reference: ACTRN12611000157976 World Health Organization Universal Trial Number: U111-1119-1755.

Effectiveness of a web- and mobile phone-based intervention to promote physical activity and healthy eating in middle-aged males: randomized controlled trial of the ManUp study.

BACKGROUND: The high number of adult males engaging in low levels of physical activity and poor dietary practices, and the health risks posed by these behaviors, necessitate broad-reaching intervention strategies. Information technology (IT)-based (Web and mobile phone) interventions can be accessed by large numbers of people, yet there are few reported IT-based interventions targeting males' physical activity and dietary practices. OBJECTIVE: This study examines the effectiveness of a 9-month IT-based intervention (ManUp) to improve the physical activity, dietary behaviors, and health literacy in middle-aged males compared to a print-based intervention. METHODS: Participants, recruited offline (eg, newspaper ads), were randomized into either an IT-based or print-based intervention arm on a 2:1 basis in favor of the fully automated IT-based arm. Participants were adult males aged 35-54 years living in 2 regional cities in Queensland, Australia, who could access the Internet, owned a mobile phone, and were able to increase their activity level. The intervention, ManUp, was based on social cognitive and self-regulation theories and specifically designed to target males. Educational materials were provided and self-monitoring of physical activity and nutrition behaviors was promoted. Intervention content was the same in both intervention arms; only the delivery mode differed. Content could be accessed throughout the 9-month study period. Participants' physical activity, dietary behaviors, and health literacy were measured using online surveys at baseline, 3 months, and 9 months. RESULTS: A total of 301 participants completed baseline assessments, 205 in the IT-based arm and 96 in the print-based arm. A total of 124 participants completed all 3 assessments. There were no significant between-group differences in physical activity and dietary behaviors (P≥.05). Participants reported an increased number of minutes and sessions of physical activity at 3 months (exp(ß)=1.45, 95% CI 1.09-1.95; exp(ß)=1.61, 95% CI 1.17-2.22) and 9 months (exp(ß)=1.55, 95% CI 1.14-2.10; exp(ß)=1.51, 95% CI 1.15-2.00). Overall dietary behaviors improved at 3 months (exp(ß)=1.07, 95% CI 1.03-1.11) and 9 months (exp(ß)=1.10, 95% CI 1.05-1.13). The proportion of participants in both groups eating higher-fiber bread and low-fat milk increased at 3 months (exp(ß)=2.25, 95% CI 1.29-3.92; exp(ß)=1.65, 95% CI 1.07-2.55). Participants in the IT-based arm were less likely to report that 30 minutes of physical activity per day improves health (exp(ß)=0.48, 95% CI 0.26-0.90) and more likely to report that vigorous intensity physical activity 3 times per week is essential (exp(ß)=1.70, 95% CI 1.02-2.82). The average number of log-ins to the IT platform at 3 and 9 months was 6.99 (SE 0.86) and 9.22 (SE 1.47), respectively. The average number of self-monitoring entries at 3 and 9 months was 16.69 (SE 2.38) and 22.51 (SE 3.79), respectively. CONCLUSIONS: The ManUp intervention was effective in improving physical activity and dietary behaviors in middle-aged males with no significant differences between IT- and print-based delivery modes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12611000081910; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000081910 (Archived by WebCite at http://www.webcitation.org/6QHIWad63).

WALK 2.0 - using Web 2.0 applications to promote health-related physical activity: a randomised controlled trial protocol.

BACKGROUND: Physical inactivity is one of the leading modifiable causes of death and disease in Australia. National surveys indicate less than half of the Australian adult population are sufficiently active to obtain health benefits. The Internet is a potentially important medium for successfully communicating health messages to the general population and enabling individual behaviour change. Internet-based interventions have proven efficacy; however, intervention studies describing website usage objectively have reported a strong decline in usage, and high attrition rate, over the course of the interventions. Web 2.0 applications give users control over web content generated and present innovative possibilities to improve user engagement. There is, however, a need to assess the effectiveness of these applications in the general population. The Walk 2.0 project is a 3-arm randomised controlled trial investigating the effects of "next generation" web-based applications on engagement, retention, and subsequent physical activity behaviour change. METHODS/DESIGN: 504 individuals will be recruited from two sites in Australia, randomly allocated to one of two web-based interventions (Web 1.0 or Web 2.0) or a control group, and provided with a pedometer to monitor physical activity. The Web 1.0 intervention will provide participants with access to an existing physical activity website with limited interactivity. The Web 2.0 intervention will provide access to a website featuring Web 2.0 content, including social networking, blogs, and virtual walking groups. Control participants will receive a logbook to record their steps. All groups will receive similar educational material on setting goals and increasing physical activity. The primary outcomes are objectively measured physical activity and website engagement and retention. Other outcomes measured include quality of life, psychosocial correlates, and anthropometric measurements. Outcomes will be measured at baseline, 3, 12 and 18 months. DISCUSSION: The findings of this study will provide increased understanding of the benefit of new web-based technologies and applications in engaging and retaining participants on web-based intervention sites, with the aim of improved health behaviour change outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12611000157976.

What kinds of website and mobile phone-delivered physical activity and nutrition interventions do middle-aged men want?

Within a health context, men in Western societies are a hard-to-reach population who experience higher rates of chronic disease compared with women. Innovative technology-based interventions that specifically target men are needed; however, little is known about how these should be developed for this group. This study aimed to examine opinions and perceptions regarding the use of Internet and mobile phones to improve physical activity and nutrition behaviors for middle-aged men. The authors conducted 6 focus groups (n = 30) in Queensland, Australia. Their analyses identified 6 themes: (a) Internet experience, (b) website characteristics, (c) Web 2.0 applications, (d) website features, (e) self-monitoring, and (f) mobile phones as delivery method. The outcomes indicate that men support the use of the Internet to improve and self-monitor physical activity and dietary behaviors on the condition that the website-delivered interventions are quick and easy to use, because commitment levels to engage in online tasks are low. Participants also indicated that they were reluctant to use normal mobile phones to change health behaviors, although smartphones were perceived to be more acceptable. This pilot study suggests that there are viable avenues to engage middle-aged men in Internet- or in mobile-delivered health interventions. This study also suggests that to be successful, these interventions need to be tailor-made especially for men, with an emphasis on usability and convenience. A wider quantitative study would bring further support to these findings.

Design, development, and use of conversational agents in rehabilitation for adults with brain-related neurological conditions: a scoping review.

OBJECTIVE: The objective of this review was to identify how conversational agents are designed and used in rehabilitation for adults with brain-related neurological conditions. INTRODUCTION: Adults with brain-related neurological conditions experience varied cognitive and functional challenges that can persist long term. However, rehabilitation services are time- and resource-limited, and novel rehabilitation approaches are warranted. Conversational agents provide a human-computer interface with which the user can converse. A conversational agent can be designed to meet specific user needs, such as rehabilitation and support. INCLUSION CRITERIA: Studies focused on the design and use of conversational agents for rehabilitation for people aged 18 years or older with brain-related neurological conditions were considered for inclusion. Eligible publication types included peer-reviewed publications (quantitative, qualitative, and/or mixed methods study designs; research protocols; peer-reviewed expert opinion papers; clinical studies, including pilot trials; systematic or scoping reviews), full conference papers, and master's or PhD theses. Eligible types of research included prototype development, feasibility testing, and clinical trials. METHODS: Online databases, including MEDLINE, Scopus, ProQuest (all databases), Web of Science, and gray literature sources were searched with no date limit. Only English publications were considered due to a lack of resourcing available for translations. Title and abstract screening and full-text review were conducted by two independent reviewers. Data extraction was shared by three independent reviewers. The data extraction instrument was iteratively refined to meet the requirements of all included papers, and covered details for technological aspects and the clinical context. Results are presented narratively and in tabular format, with emphasis on participants, concept and context, and data extraction instrument components. RESULTS: Eleven papers were included in the review, which represented seven distinct conversational agent prototypes. Methodologies included technology description (n = 9) and initial user testing (n = 6). The intended clinical cohorts for the reported conversational agents were people with dementia (n = 5), Parkinson disease (n = 2), stroke (n = 1), traumatic brain injury (n = 1), mixed dementia and mild cognitive impairment (n = 1), and mixed dementia and Parkinson disease (n = 1). Two studies included participants who were healthy or otherwise from the general community. The design of the conversational agents considered technology aspects and clinical purposes. Two conversational agent prototypes incorporated a speaking humanoid avatar as reported in five of the papers. Topics of conversation focused on subjects enjoyable to the user (life history, hobbies, where they lived). The clinical purposes reported in the 11 papers were to increase the amount of conversation the user has each day (n = 4), reminiscence (n = 2), and one study each for anxiety management and education, Parkinson disease education, to obtain and analyze a recording of the user's voice, to monitor well-being, and to build rapport before providing daily task prompts. One study reported clinician oversight of the conversational agent use. The studies had low sample sizes (range: 1-33). No studies undertook effectiveness testing. Outcome measures focused on usability, language detection and production, and technological performance. No health-related outcomes were measured. No adverse events were reported, and only two studies reported safety considerations. CONCLUSIONS: Current literature reporting the design and use of conversational agents for rehabilitation for adults with brain-related neurological conditions is heterogeneous and represents early stages of conversational agent development and testing. We recommend, as per our customized data extraction instrument, that studies of conversational agents for this population clearly define technical aspects, methodology for developing the conversation content, recruitment methods, safety issues, and requirements for clinician oversight.

The telemedicine community readiness model-successful telemedicine implementation and scale-up.

To successfully scale-up telemedicine initiatives (TIs), communities play a crucial role. To empower communities fulfilling this role and increase end users' acceptance of TIs, support tools (from now on entitled artifacts) are needed that include specific measures to implement and scale up telemedicine. Addressing this need, the article introduces the Telemedicine Community Readiness Model (TCRM). The TCRM is designed to help decision-makers in communities to create a favorable environment that facilitates the implementation and scale-up of TIs. The TCRM is a practical tool to assess communities' readiness to implement TIs and identify aspects to improve this readiness. The development process follows a design-science procedure, which integrates literature reviews and semi-structured expert interviews to justify and evaluate design decisions and the final design. For researchers, the paper provides insights into factors that influence telemedicine implementation and scale-up (descriptive role of knowledge) on the community level. For practitioners, it provides a meaningful tool to support the implementation and scale-up of TIs (prescriptive role of knowledge). This should help to realize the potential of telemedicine solutions to increase access to healthcare services and their quality.